A case of Barrett's oesophagus in pernicious anaemia: acid is not the only culprit!

A 46-year-old female presented at our department with the onset of episodic dyspeptic symptoms, mainly postprandial fullness and bloating, as well as paresthesia. A blood test revealed the presence of mild macrocytic anaemia (haemoglobin 11.3 g/dl; mean corpuscular volume 119 fl), a reduced level of vitamin B12 (60 pmol/l; normal 200–750 pmol/l), hypergastrinaemia (1363 pg/ml; normal for female <100 pg/ml), a low level of pepsinogen I (<2.6 pg/ml; normal 30–100 pg/ml), and positivity for antibodies against parietal cells (>1:100). The upper endoscopy showed in oesophagus a single linear erosion (grade A according to Los Angeles Classification), with an absence of macroscopic gastric abnormalities. At histology, mucosal severe atrophy with moderate intestinal metaplasia was found in fundus and gastric corpus with spared antrum, in the absence of Helicobacter pylori infection. A diagnosis of autoimmune gastritis with pernicious anaemia was therefore made, and the patient started vitamin B12 intramuscular injections. Due to the absence of specific symptoms such as heartburn and/or regurgitation and to the presence of autoimmune gastritis, the erosive oesophagitis was not treated. After 4 weeks of treatment with vitamin B12, the haemoglobin, mean corpuscular volume and vitamin B12 values were restored, paresthesia improved, while dyspepsia remained stable, with sporadic symptoms about once a week.